EXHIBIT A
MIDDLE TENNESSEE STATE UNIVERSITY
APPLICATION TO BRING FOOD ON CAMPUS
(Please Print)
Exceptions to this policy will not be granted for the following locations: the James Union Building Tennessee Room and dining rooms, new
student union ballroom, or other facilities that are dedicated/assigned to food service use.
Date __________________________
Please check one:
□
Request for “potluck” type dinner or unique food event (requires signatures 1 and 2)
□
Request for fundraising activity in student programming area (requires signatures 1 and 2)
□
Request for fundraising activity in other locations (requires signatures 1, 2, 4, and 5)
□
Request for off-campus caterer (requires signatures 1, 2, 3, and 4)
1.
Organization/Group name _________________________________________________________________________
2.
Purpose of Activity ______________________________________________________________________________
3.
Date of the Activity __________________ Time __________________ Number of participants _________________
4.
Location: Building _____________________________________
5.
Is the food to be sold? Yes _____
No _____If yes, attach a list of prices.
(Note: Sales of food items by student groups must also meet fund-raising approval requirements outlined in the Rights and Responsibilities
handbook.)
6.
Is the activity open to the general public?
7.
Specify the exact types of food and/or soft drink desired to bring on campus: ________________________________
______________________________________________________________________________________________
8.
Why do you not want to use MTSU Food Services? (Note cost alone may not justify exception.)
______________________________________________________________________________________________
9.
Applicant (Responsible Person): (Print) ______________________________________________________________
Yes _____
Room ________________________
No_____
Local/Office Address ____________________________________________________________________________
Office/Work Phone ________________________
Home/Residence Hall Phone _____________________
Applicant’s Signature: _______________________________________________________________________________
If a MTSU Student Organization, Faculty/Staff, Advisor/Sponsor Signature: ____________________________________
REQUIRED APPROVAL SIGNATURES
1.
_________________________________________________
Facility Director where event will be held or Designee
Date: _________________________
2.
_________________________________________________
Student Organizations Office or Department/Activity Head
Date: _________________________
3.
_________________________________________________
Food Services Director or Designee
Date: _________________________
4.
__________________________________________________
Vice President/Dean/Division Head or Designee
Date: _________________________
5.
__________________________________________________
Vice President for Business & Finance or Designee
Date: _________________________
Original copy of this form must be routed and approved in sufficient time to allow final approval five (5) days prior to the event.